Provider Demographics
NPI:1952928137
Name:FERNANDO, AMBERLEY REBECCA ROSE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMBERLEY
Middle Name:REBECCA ROSE
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 OPAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3732
Mailing Address - Country:US
Mailing Address - Phone:336-488-7435
Mailing Address - Fax:
Practice Address - Street 1:1811 OPAL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-3732
Practice Address - Country:US
Practice Address - Phone:336-488-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered